Professional Documents
Culture Documents
1
Communicable Diseases
Infectious
Communicable
Contagious
2
Communicable Diseases
Host
Environment Agent
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4
Modes of Transmission
Direct
Congenital, Sexual, Direct Contact
Indirect
Fomite
Vector
Mechanical, Biological
Vehicle
Airborne, waterborne
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ASEPSIS AND INFECTION CONTROL
Asepsis- absence of disease producing
microorganisms
Medical Asepsis
“clean technique”
Reduces number of microorganisms
Surgical Asepsis
“sterile technique”
Includes all sterile procedure/techniques to
eliminate all microorganisms from an area
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Cleansing, Disinfection, Sterilization
Cleansing- removing visible dirt
Disinfection- reduce number of potential
pathogens but spores are not
necessarily destroyed
Sterilization- complete destruction of all
microorganisms including their spores
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Methods:
1. Steam (autoclave)
2. Gas (Ethylene oxide)
3. Radiation
4. Chemical
5. Boiling water
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Infection Control
Handwashing- single most important
infection control practice
Necessary elements:
Friction
Running water
Cleansing agent
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Removing protective devices:
1. Gloves
2. Mask
3. Gown
4. Goggles
5. Cap
6. Shoe cover
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the tiers of precaution
Standard precaution
Transmission-based precaution
Airborne precaution – droplet nuclei smaller
than 5 μm
High-Efficiency Particulate Air filter
Air-filtered room
Private room
Door is shut
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the tiers of precaution
Standard precaution
Transmission-based precaution
Droplet precaution – droplet nuclei larger
than 5 μm
Door may be open
Mask if within 3 feet
Limit transport
Private room
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the tiers of precaution
Standard precaution
Transmission-based precaution
Contact precaution
Gown and gloves
Dedicated equipment
Private room
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Principles of Sterility
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Principles of Sterility
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Principles of Sterility
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Respiratory System
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Respiratory System
Upper Respiratory
Tract
Lower Respiratory
Tract
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Respiratory System
19
Respiratory System
Lower Respiratory Tract
Bronchioles
Terminal Bronchioles
Respiratory
Bronchioles
Alveoli
Type I
Type II
Alveolar
Macrophages (Dust
Cells)
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Respiratory System
Lungs
Pleural Membrane
Parietal Pleura
Visceral Pleura
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Respiratory System
Pulmonary Ventilation
Inspiration and
Expiration
Cellular Respiration
External
Internal
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Respiratory System
Muscles of
Respiration
Quiet Respiration
Piston Action
Pump Handle Motion
Bucket Handle Motion
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Respiratory System
Mechanics
Forced Inspiration
Quiet Expiration
Forced Expiration
29
Respiratory System
Lung Volumes
Tidal Volume (500 ml)
Inspiratory Reserve Volume (IRV = 2100-
3200 ml)
Expiratory Reserve Volume (ERV = 1200 ml)
Residual Volume (RV =1200 ml)
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Respiratory System
Lung Capacities
Inspiratory Capacity (=4000 ml)
Vital Capacity (= 4800 ml)
Functional Residual Capacity (=2000 ml)
Total Lung Capacity (=6000 ml)
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Respiratory System: Control
Respiratory Center
In the medulla and pons
Medullary rhythmicity area
Pneumotaxic area (>E)
Apneustic area (>I)
Cerebral Cortex
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Respiratory System: Control
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Respiratory System: Control
Chemoreceptors
Central
Peripheral
Aortic and carotid bodies
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Respiratory System: Control
Others
Temperature
Irritation of airways
Volition
Pain
Emotion
Anal Sphincter Stretching
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Assessment
Health History
chief complaint
impact on patient's life
if chronic, ongoing assessment of abilities
& quality of life
Signs & Symptoms
Dyspnea
difficulty breathing
due to decreased lung compliance or
increased airway resistance
Signs & Symptoms
Cough
from irritation of the membranes
chief protection against accumulation of
secretions
Signs & Symptoms
Sputum
reaction of lungs to any constantly
recurring irritant
profuse & with color usually is bacterial
thin & mucoid is viral
bad breath usually is respiratory in origin
Signs & Symptoms
Wheezing
heard with airway narrowing
high-pitched, mainly expiratory
Signs & Symptoms
Clubbing
distal phalanx of each finger is
bulbous & rounded
nail plate is more convex
usually due to chronic hypoxia
may be pulmonary or cardiac
Signs & Symptoms
Hemoptysis
expectoration of blood
underlying disease must be diagnosed
regardless of amount of blood
vs. Hematemesis
Signs & Symptoms
Cyanosis
a very late indicator of hypoxia
appears at 5g/dL of unoxygenated Hgb
best to observe color of tongue & lips
Physical Assessment
Thorax
check skin color & turgor
check for deformities
Physical Assessment
Thorax
Funnel Chest (Pectus
excavatum)
depression of lower
portion of the sternum
may compress the
heart
Physical Assessment
Thorax
Pigeon Chest (Pectus Carinatum)
due to displacement of the sternum
increase in AP diameter
Physical Assessment
Thorax
Barrel Chest
due to overinflation
of the lung
increase in AP
diameter
Physical Assessment
Thorax
Kyphoscoliosis
elevation of scapula
S-shaped spine
Physical Assessment
Respiratory Rates
normal RR: 12-18 bpm
Eupnea
Bradypnea
Tachypnea
Physical Assessment
Breathing Patterns
Hypoventilation
Hyperpnea (depth)
Hyperventilation (depth and rate)
Apnea
Physical Assessment
Breathing Patterns
Kussmaul's
Cheyne-stokes
Biot's (Cluster)
Apneustic
Physical Assessment
Thoracic Palpation
tenderness, masses
respiratory excursion
costal margin if anterior
level of 10th rib if posterior
Physical Assessment
Thoracic Palpation
tactile fremitus
vibration of the chest
patient asked to repeat "99", "eee"
air impedes sound, solids conduct sound
Physical Assessment
Thoracic Percussion
to determine content of underlying structures
to estimate size & location of certain
structures within the thorax
dullness at left 3rd - 5th interspace is the heart
dullness at right 5th interspace to costal
margin is the liver
Physical Assessment
Thoracic Auscultation
Useful for assessing air flow
Used to evaluate presence of fluid or solid
obstruction
Allow patient to rest during examinations
Physical Assessment
Thoracic Auscultation
Adventitious Sounds
“additional” sounds
Crackles (Rales)
Wheezing
Diagnostics
Imaging Studies
Endoscopic Procedures
Bronchoscopy
Thoracoscopy
Respiratory System: Tests
Pulse Oximetry
Spirometry
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Diagnostics
Procedures
Thoracentesis
Biopsy
Pleura
Lung
Lymph Node
Client Needs: Oxygenation
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Client Needs: Oxygenation
Interventions to promote
oxygenation
Chest physiotherapy
a. Percussion
b. Vibration
c. Postural Drainage
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Client Needs: Oxygenation
Oxygen Therapy
Concentration and liter flow
per minute
Humidification
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Obstruction and Trauma
Epistaxis
Caused by rupture of tiny vessels in any area
of the nose
Most commonly over the anterior septum
where the following vessels enter:
Kesselbach’s plexus
Sphenopalatine artery (posterosuperior)
Internal maxillary (lateral)
Obstruction and Trauma
Epistaxis (treatment)
Direct pressure
Silver nitrate, electrocautery
Packing
May remain in place for 48 hours
Upper Respiratory Tract
Acute Sinusitis
Infection of the paranasal
sinuses
Usually due to drainage
obstruction
60% are bacterial
Upper Respiratory Tract
Chronic Sinusitis
• > 3 wks in adults, > 2 wks in children
• Same organisms as acute sinusitis
• Symptoms most pronounced in the
morning
Upper Respiratory Tract
Rhinitis
Inflammation and irritation of the mucus
membranes
non-allergic or allergic
Sx: rhinorrhea
Nursing
Avoid the allergen
Blow the nose before any medication in the
nasal cavity
Upper Respiratory Tract
Acute Pharyngitis
• Mostly viral
• The most common bacterial cause is
group A beta-hemolytic Streptococci
• Throat cultures, nasal swabs and blood
cultures may be necessary
Upper Respiratory Tract
Laryngitis
• Inflammation of larynx
• Almost always viral if
infectious
• With voice changes
and cough
Obstruction and Trauma
Laryngospasm
Trauma or inflammatory
Intervention
Oxygen
Succinylcholine
Obstruction and Trauma
Laryngeal Paralysis
Most common complication of
thyroidectomy, one vocal cord only
Ineffective cough
Prevent aspiration
Obstruction and Trauma
Pulmonary Tuberculosis
Primarily an infection of the lung, it may
also involve other body parts
The agent is Mycobacterium tuberculosis
The leading cause of death from
infectious disease in the world
Lower Respiratory Tract
Pneumonia
• Inflammation of
lung
parenchyma
caused by
infection
Lower Respiratory Tract
Pneumonia
CAP
In community or first 48 hours of hospitalization
S. pneumoniae is the most common cause
Mycoplasma is common in older children and
young adults
H. influenzae affects the elderly and those with
comorbids
Viruses are the most common cause in infants
and children
Lower Respiratory Tract
Pneumonia
CAP
In adults, the most common viruses are the
influenza, adenovirus, parainfluenza,
coronavirus and varicella-zoster
In immunocompromized adults, CMV is the
most common
Lower Respiratory Tract
Pneumonia
HAP
Nosocomial
The most lethal nosocomial infection
Commonly includes Enterobacter, E. coli,
Klebsiella, Pseudomonas and Staphylococcus
Lower Respiratory Tract
Pneumonia
In the immunocompromised host
Pneumocystis carinii
Fungal
Mycobacterial
Aspiration
S. pneumonia, H. influenzae, S. aureus
Pleura
Pleuritis
Inflammation of the pleura
Worse with deep breathing, coughing or
sneezing (respiratory movement)
Analgesics and find underlying cause
Turn to the affected side
Pleura
Pleural Effusion
Accumulation of fluid in the pleural space
The size of the effusion and the underlying
disease determine the severity
Most commonly due to infection or malignancy
Chemical pleurodesis, pleurectomy,
thoracentesis may be done
Pleura
Empyema
Localized collection of pus
May thicken pleura and restrict the lung
Usually complications of lung infection,
trauma or surgery
Requires 4-6 weeks of antibiotics
Thoracentesis, thoracostomy may be
done
Lower Respiratory Tract
Bronchitis
• Acute
– Fever, cough,
wheezing
• Chronic
– Cough worse in the
evening and morning
– Lasts 3 months for 2
consecutive years
Lower Respiratory Tract
Bronchitis
Treatment
Bronchodilators, corticosteroids
Postural drainage and chest percussion
Bronchiectasis
Treatment
Bronchodilators
Oxygen therapy; be careful not to depress
respiratory drive
Nursing Management
Smoking cessation
Diaphragmatic breathing
Pursed-lip breathing
Inspiratory muscle training
Acute Respiratory Failure
Cor Pulmonale
Right ventricular enlargement secondary
to a pulmonary condition
Confusion and somnolence may be
present due to hypercapnia
Symptoms of underlying disease
Symptoms of heart failure
Pulmonary Heart Disease
Cor Pulmonale
Oxygen therapy and bronchodilators
Intubation and mechanical ventilation
Treatment of CHF
Pulmonary Edema
• Pneumothorax
– Traumatic
Pneumothorax
– Tension Pneumothorax
– Hemothorax
– Chest tube placement
(2nd or 4th /5th )
CTT
Respiratory Care Modalities
Non-invasive
Oxygen Therapy
Nebulizer
Postural Drainage
Breathing Retraining
2-6 lpm
5-8 lpm
6-10 lpm
10-15 lpm
4-10 lpm
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Respiratory Care Modalities
Invasive
• Endotracheal
Intubation
• Tracheostomy
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Suctioning
Oropharyngeal
10-15 cm along side of mouth
Nasopharyngeal
Along floor
10-15 sec, rotate, 20-30 sec intervals, 5 min
total
Avoid complications
Hyperinflation
Hyperoxygenation
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